DESCRIPTION (Applicant's Abstract) Although much is now known about asthma, and there is effective asthma treatment, only about half of the patients with persistent asthma adhere to their prescribed long-term controller medication. One way to change this might be to involve patients more in decisions about their treatment. We propose a five-year project to develop and evaluate the effectiveness of a new model of clinician-patient interaction, shared decision-making, in improving outcomes in adults aged 18-70 years with suboptimally controlled, mild- moderate persistent asthma. The shared decision-making model (SD) will be compared in a randomized, controlled clinical trial with a model based on national asthma guidelines (MG), and with usual care (UC). Primary outcomes will be asthma-related quality of life and acute asthma health care; secondary outcomes will be asthma control, adherence, symptom-free days, lung function, dispensings of asthma medications, satisfaction with asthma care, asthma- related costs, and total asthma-related health care utilization. The project will be carried out in Kaiser Permanente Northwest (KPNW) and KP Hawaii (KPH) and will have two phases. In Phase 1 we will adapt the two intervention programs from asthma education programs that we have developed, and shared decision-making programs developed by our consultants. We will pretest them to ensure that they are culturally appropriate for the target populations. In the second phase, the randomized clinical trial, we will recruit 342 patients (2/3 from KPNW and 1/3 from KPH) with suboptimally controlled persistent asthma, using the KP administrative databases. Eligible patients will be randomized on a 1:1:1 basis into three groups: management by shared decision- making, management by guidelines, and usual care. Patients in the two intervention groups will each meet with a care manager for two one-hour sessions, have their management plan reviewed and modified as necessary using the model for their group assignment, and will subsequently be called at three, six, and nine months. All participants will be followed for two years with outcome data collected at 12 and 24 months. If effective, this model can be incorporated into clinical practice to improve asthma outcomes and reduce costs.